Military Ombud Act, 2012 (Act No. 4 of 2012)

Regulations

Military Omud Complaints Regulations 2015

Annexures

Annexure B : Military Ombud : Application for Condonation

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ANNEXURE B

CONFIDENTIAL

MILITARY OMBUD

APPLICATION FOR CONDONATION

Please Note:

Kindly complete the form in a legible manner and complete all the pages that are relevant to you.

Please note that the fields marked with an asterix (*) are compulsory.

PARTICULARS OF COMPLAINT

Category of Complainant (*):

❑	Current SANDF Member

❑	Former Member of the SANDF

❑	Member of the Public

❑	Third Party (e.g. union rep, lawyer, etc.)

PERSONAL DETAILS (If you are the member, former member or member of the public lodging the complaint please complete this section only where applicable)

Please indicate your Gender and Race(*) : (This information is required for statistical purposes)

❑

Male

❑

Female

Race:

______________________________________

Race: ________________________

Surname (*): _____________________________Full Names(*): __________________________

Title (Mr/Mrs/Miss/Ms/Dr/Prof (*): _________________Rank : __________________________

ID/Passport Number (*) ________________________________Force Number: _____________

Unit: ________________________________Service Division: ____________________________

Residential Address (*): __________________________________________________________

Postal Address (*): ______________________________________________________________

City: __________________Province: Postal Code: __________________

Telephone (*) Home: _______________Cell: _________________Work: ___________________

Email Address: __________________________________Fax : ____________________________

AFFIDAVIT

I, the undersigned, (Full name of Applicant) ___________________________________________ do hereby make oath and say:

1.	BACKGROUND

1.1.	The complaint arose on ________________________after all attempts to negotiate or follow internal procedures at the respondent (the Department) failed.

1.2.	I, the applicant, followed the following internal procedure:__________________

______________________________________________________________________

2.	THE DEGREE OF LATENESS

2.1.	The referral is ________________days late. (excluding the 180 day and 90 day period, whichever is applicable, as provided in Military Ombud Complaints Regulations of 2015)

3.	REASONS FOR THE LATE SUBMISSION

_____________________________________________________________________________

4.	THE PROSPECTS OF SUCCESS BASED ON THE MERITS OF THE COMPLAINT LODGED

_____________________________________________________________________________

5.	POSSIBLE PREJUDICE TO BE SUFFERED BY THE COMPLAINANT IF THE MATTER IS NOT INVESTIGATED

_____________________________________________________________________________

6.	POSSIBLE PREJUDICE TO ANY PARTY HAVING A SUBSTANTIAL INTEREST IN THE OUTCOME OF THE COMPLAINT IF THE MATTER IS OR IS NOT INVESTIGATED

_____________________________________________________________________________

7.	ANY OTHER RELEVANT FACTORS

_____________________________________________________________________________

_____________________________________________

SIGNATURE OF APPLICANT

Signed before me on _____________________________ at _____________________________ by the deponent who acknowledges that he/she knows and understands the contents of the affidavit, had no objection to taking the oath/affirmation and considers it binding on his/her conscience.

Commissioner of Oaths:

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

Capacity: ____________________________________________________________________________

Military Ombud Act, 2012 (Act No. 4 of 2012)

Regulations

Military Omud Complaints Regulations 2015

Annexures

Annexure B : Military Ombud : Application for Condonation

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